Prathyusha Darapu

Lead - Rmra Data Management & Analytics @Health Alliance Plan

Lead Analyst with extensive knowledge on Medicaid, MMP, Medicare Advantage programs and FACETS claims, membership and provider subject areas. My work involves - 1. Encounter Data Submissions to State/CMS (EDPS & RAPS)- 837 Professional, Institutional, Dental & Pharmacy Data submissions to State and CMS - Risk adjustment data analysis through CDPS model, gaps analysis, decision making and improvements 2. Encounter Data Management - Encounter Data validations, EDI testing, Response files tracking & validations, Reconciliation, Error Management, Root Cause Analysis, acceptance rate improvement, analytical reporting etc, 3. Compliance activities - Over Payment Reports submission to OIG, Encounter Comparison Report submissions to MDHHS, Updating policies & Procedures etc, 4. Data Analytics - create Alteryx workflows for encounter reconciliation reports, error trends, acceptance rates, EDM testing etc - create power BI dashboards with drill down capabilities to add visibility on end to end claims/ encounter cycle, CDPS risk scores, gaps identification, prioritization etc, 5. Data decisions - to improve data quality, Encounter data submissions, Acceptance rates and Risk scores (CDPS/RAPS) etc, 6. Extensive Collaboration with different departments in the organization as well as vendors to discuss on various topics, resolve issues and to make decisions 7. Keeping up to date with MDHHS and CMS encounter/Risk Adjustment updates and requirements. MI & Core reporting requirements Skills: Extensive use of SQL, excel, Alteryx tool, power BI. Teams collaboration, Root Cause Analysis, Documentation for BRD, STM, LLD, HLD etc, 5. Data Analysis expert with extensive use of SQL for both Oracle and SQL Server DBs and excel. ETL Expert - Extensively used DataStage to create extracts, to load data into EDW/DataMart etc, 7. Reporting - used Power BI to create analytical dashboards for Data Quality, Alteryx for reporting, analytics.